General Information
Human papilloma virus (HPV) is one of the most common sexually transmitted diseases (STDs) in the world. Experts estimate that as many as 24 million Americans are currently infected with genital HPV and nearly 74 percent of sexually active Americans have been infected with genital HPV at one point in their lives (1). Young women are especially at risk for HPV-one study reported that 60 percent of female college students were infected with the virus at some point during these years (3).
There are over 70 different types of HPV, and not all of them are sexually transmitted. For example, some types of the virus may cause the common warts found on hands and feet and do not cause genital warts. About one-third of the different types of HPV are spread through sexual contact and can cause genital warts. Like many STDs, HPV may cause a silent infection -- one that does not have visible symptoms (3). Because it may be difficult to tell if you are infected, there is the potential risk that the infection will become more serious, if left untreated. You may also transmit the virus unknowingly to others. If you are sexually active, it is important to go for yearly Pap Smear tests so that HPV and genital warts can be detected as early as possible.
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What Causes Genital HPV and Genital Warts?
Genital HPV is passed from one person to another by sexual contact and may cause warts to appear in or around the vagina, anus, and less commonly, the cervix. Although vaginal and anal sex are the most common means to transmit the virus, exchange of bodily fluids is not necessary in order to become infected! Just touching another genital wart is enough contact to catch the disease. Genital warts can also develop in the mouth or throat of a person who has had oral sex with an infected partner, although this is very rare. Transmission of the disease is most likely when genital warts are visible, but people with the HPV virus without visible genital warts are still contagious.
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Am I at Risk?
Anyone who has had sexual contact with an infected person is at risk for HPV and genital warts. Even if you do catch the virus, you might not be able to see any changes because the virus can remain latent for up to several years or even a lifetime. (4) If you use male or female condoms, you are still susceptible to infection, since the virus can be passed on through just touching the infected area. Having multiple sexual partners or engaging in sexual activity with people you don't know very well places you in greater risk for contracting HPV or genital warts, as well as many other STDs.
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How do I know if I have HPV or Genital Warts?
Genital HPV is passed from one person to another by sexual contact and may cause warts to appear. HPV is often asymptomatic (shows no symptoms) so a person may not know they have the disease even though they are contagious. However, when genital warts caused by the virus do occur they can appear in or around the vagina, anus, and less commonly, the cervix. The warts often appear flesh-colored or grayish-white. They can be tiny or large and can occur in clusters or alone. They are usually painless, but some people may have itching, burning, or slight bleeding from these areas. (5) If you notice any of these changes, contact your local health-care provider.
For pictures of genital warts, visit thebody.com or Health Central.
But be warned that many of these pictures are very graphic and represent extreme stages of infection.
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Diagnosis
A doctor can usually diagnose genital warts by direct visual examination. Women with genital warts also should be examined for possible HPV infection of the cervix. The doctor may be able to identify some otherwise invisible changes in the tissue of the cervix by applying vinegar (acetic acid) to areas of suspected infection. This solution causes infected areas to whiten, which makes them more visible, particularly if a procedure called colposcopy is performed. During colposcopy, a magnifying instrument is used to view the vagina and uterine cervix. In some cases, it is necessary to do a biopsy of cervical tissue. This involves taking a small sample of tissue from the cervix and examining it under the microscope to look for an infection.
A Pap smear test also may indicate the presence of cervical HPV infection. A Pap smear is a microscopic examination of cells from the cervix. The presence of abnormal cells can be associated with HPV infection.
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Am I at Risk for Cancer?
You may have heard that HPV or genital warts cause cervical cancer. Although cervical cancer can be traced back to a few different types of HPV, cervical cancer itself is a rare disease. Studies suggest that whether or not a person will develop cancer depends on a variety of factors that act together with HPVs. These factors include smoking, decreased resistance to infection, and infections with agents other than HPVs. In addition, behaviors that increase a person's chance of getting an HPV infection, such as beginning sexual intercourse at an early age and having many sexual partners, are also risk factors for the development of cervical cancer. Frequent Pap smears and careful medical follow-up, with treatment if necessary, can help ensure that the mild abnormalities in the cervix caused by HPV infection do not develop into cancer.
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Is there Treatment for HPV or Genital Warts? (5, 7)
Currently, there is no treatment for HPV. Once a person is infected, the virus remains in the body forever. However, the virus may become inactive and not cause any changes or symptoms. Genital warts caused by HPV can be treated by removal through several means, including the following methods:
- Podofilox cream or gel - a prescription cream that you can apply yourself
- Imiquimod cream - another prescription cream that is self-applied
- TCA (trichloracetic acid) - a chemical applied by a doctor or nurse to surface of wart
- Cryotherapy - freezing off smallwarts with liquid nitrogen
- Electrocautery - burning off small warts with an electrical instrument
- Laser treatment - destroying larger warts with intense light. This method may be more expensive and less widely available
- Interferon - an antiviral drug inserted into recurrent warts. This drug is expensive, does not prevent recurrence, and has many side effects and so isn't very common.
Even after warts are removed, there is a chance of recurrence. However, over time, the frequency of recurrences decreases, and outbreaks may be eliminated entirely after about two years. Illness, medication, or stress, however, may prevent the body from fully preventing recurrences. Although it may be difficult with exams and the stresses of everyday life to take care of yourself, eating healthy, exercising, and getting enough sleep are important factors in enhancing you ability to fight off infections.
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Prevention
Since HPV infection is caused by direct contact with the virus through sexual activity, the best protection is to abstain from sex. But if you do decide to have sex:
- Don't engage in sexual contact with someone who has untreated genital warts
- Don't touch warts or areas that have been infected with HPV
- Always use a latex condom. But since the condom doesn't cover the entire genital area, there is still risk of infection (8).
- Limit your amount of sexual partners. Multiple partners increase your chance of contracting any STD including HPV.
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References
1 http://www.ashastd.org/hpvccrc/hpvmyth.html
2 Gloria Y.F. Ho, et al., "Natural History of Cervicovaginal Papillomavirus Infection in Young Women," New England Journal of Medicine 338.7 (1998): 423-428.
3 http://www.niaid.nih.gov/factsheets/stdhpv.htm
4 http://www.ashastd.org/hpvccrc/hpvmyth.html
5 http://obgyn.uihc.uiowa.edu/Patinfo/STD/WARTS.HTM
6 http://www.ashastd.org/hpvccrc/gw.html
7 http://www.niaid.nih.gov/factsheets/stdhpv.htm
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